MEDICARE: DR. ELIZABETH JANE LEDBETTER PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	30816	CA
2	103TC0700X	Clinical Psychologist	4232	CO

General Provider Information

NPI Number	:	1740471325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH JANE LEDBETTER PSY.D.

Provider Business Mailing Address
First Line	:	200 E DEL MAR BLVD STE 200
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91105-2552
Country	:	US
Telephone Number	:	626-723-3099
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 E DEL MAR BLVD STE 200
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91105-2552
Country	:	US
Telephone Number	:	626-723-3099
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2007
Last Update Date	:	03/29/2019

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